Provider Demographics
NPI:1366548968
Name:SUMNER, ELIZABETH A (APN)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:SUMNER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2059
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-2059
Mailing Address - Country:US
Mailing Address - Phone:775-727-1001
Mailing Address - Fax:
Practice Address - Street 1:2100 E CALVADA BLVD
Practice Address - Street 2:VA CLINIC
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5805
Practice Address - Country:US
Practice Address - Phone:775-727-7535
Practice Address - Fax:775-751-6416
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA183998363LA2200X
PAUP001156C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS54461Medicare UPIN